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Dev sinus Valsalva anevrizmasi/Giant sinus of Valsalva aneurysm.

Sinus Valsalva anevrizmasi cok ender gorulen bir kalp hastaligidir. Bu patoloji genellikle nonkoroner sinuslerde gorulmekle birlikte, nadiren sag koroner sinusu de etkileyebilir (1). Anevrizma, olgularin hemen tamaminda aortun media tabakasi nin sinus Valsalva seviyesindeki dogumsal yokluguna baglidir (2).

Kirk yasinda erkek olgu bel, bas ve diz agrilari ile hastanemize basvurdu. Oykusunde 17 yil once prostetik kapak replasmani yapildigi, infektif endokardit tanisiyla takip ve tedavi edildi gi ogrenildi. Transtorasik ve transozofajiyal ekokardiyografide, sag atriyum icerisinde kaviter dev bir kitle saptandi.

Kontrast verilmeden once elde edilen BT goruntulerde (Resim 1A) sag atriyumu dolduran yaklasik 6.7 cm capinda sferik bir kitle izlendi. Dinamik BT goruntulerde, vena kava superiyor yoluyla kalbe ulasan kontrast maddenin sag atriyumdaki kitlenin etrafini cevreledigi (Resim 1B), sonrasinda sirasiyla sag ventrikulu, pulmoner dolasim yoluyla sol atriyumu (Resim 1C) ve sol ventrikulu (Resim 1D) opasifiye ettigi saptandi. Kitle icerisinde bu asamaya kadar kontrastlanma izlenmedi. Kontrast maddenin aorta gecisini takiben kitle santrali aort ile es zamanli dolum gosterdi (Resim 1E). Belirtilen dolum yaklasik 1 cm capindaki bir kanal yoluyla oldu (Resim 1F). Kitle icerisindeki opasifikasyon kalp odaciklarindaki kontrast maddenin yikanmasi sonrasinda da bir sure devam etti (Resim 1G ve H).

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Olgu yukaridaki bulgularla sinus Valsalva anevrizmasi tani-si aldi ve opere edildi. Sag atriyotomide, atriyuma basi yapan ve infektif endokardit sekeli oldugu dusunulen sinus Valsalva anevrizmasi dogrulandi.

Cerrahi tedavinin erken evredeki basarisi, tedavi edilmeyen olgularda gorulen yuksek mortalite ile birlesince, sinus Valsalva anevrizmalarinin erken tani almasi gerekliligi ortaya cikmaktadir (3-6). Bu nedenle mediastinal yapilari iceren BT goruntuleri ender rastlanan kardiyak patolojiler yonunden de gozden gecirilmelidir. Kaynaklar

1. Callaway M, Wilde P. Acquired heart disease I: the chest radiography. In: Sutton D, editor. 7th ed. Textbook of Radiology and Imaging. Hong Kong: Churchill Livingstone; 2003. p. 314.

2. Sakakibara S, Konno S. Congenital aneurysm of the sinus of Valsalva anatomy and classification. Am Heart J 1962; 63: 405-24.

3. Azarine A, Lions C, Koussa M, Beregi JP. Rupture of an aneurysm of the coronary sinus of Valsalva: diagnosis by helical CT angiography. Eur Radiol 2001; 11: 1371-3.

4. Ribeiro A, Fernandes F, Costeira A, Simoes A, Rodrigues P. Non-coronary sinus of Valsalva aneurysm diagnosed after a road traffic accident. Heart 1999; 82: 5.

5. Holman WL. Aneurysms of the sinuses of Valsalva. In: Sabiston DC, Spencer FC, editors. 1st ed. Surgery of the Chest. Philadelphia: WB Saunders & Co; 1995.p. 1316-26.

6. Grellner W, Karsch KR, Bultmann B. Fatal outcome of a congenital aneurysm of the right sinus of Valsalva ruptured into the right atrium. Z Kardiol 1995; 84: 553-9.

Hakki Muammer Karakas, Bayram Kahraman, Aysegul Sagir, Ahmet Kemal Firat

Inonu Universitesi Tip Fakutesi, Turgut Ozal Tip Merkezi, Radyoloji Anabilim Dali, Malatya, Turkiye
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Title Annotation:Orijinal Goruntu/Original Image; article in Turkish
Author:Karakas, Hakki Muammer; Kahraman, Bayram; Sagir, Aysegul; Firat, Ahmet Kemal
Publication:The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)
Date:Sep 1, 2006
Words:442
Previous Article:Platipneye neden olan sol atriyal miksoma olgusu/A case of left atrial myxoma as a cause of platypnea.
Next Article:A surgical salvage case with active endocarditis and aortic coarctation/Aktif endokarditli aort koarktasyonlu olguda kurtarici cerrahi girisim.


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